HEALTH INFORMATION

Discusses disorder of intestines that causes symptoms such as belly pain, cramping or bloating, and diarrhea or constipation. Covers treatment by avoiding foods that trigger symptoms, getting regular exercise, and managing stress. Includes medicines.

Discusses disorder of intestines that causes symptoms such as belly pain, cramping or bloating, and diarrhea or constipation. Covers treatment by avoiding foods that trigger symptoms, getting regular exercise, and managing stress. Includes medicines.

Irritable Bowel Syndrome (IBS)

Topic Overview

What is irritable bowel syndrome (IBS)?

Irritable bowel
syndrome (IBS) is a disorder of the intestines. It causes belly pain, cramping
or bloating, and diarrhea or constipation. IBS is a
long-term problem, but there are things you can do to reduce your symptoms.

Your symptoms may be worse or better from day to day, but your
IBS will not get worse over time. IBS doesn't cause more serious diseases,
such as
inflammatory bowel disease or cancer.

What causes IBS?

It isn't clear what causes irritable bowel syndrome. The cause may be different for different people. IBS may be caused by problems with the way signals are sent between the brain and the digestive tract, problems digesting certain foods, and stress or anxiety. People with IBS may have unusually sensitive intestines or problems with the way the muscles of the intestines move.

For some people with IBS, certain
foods, stress, hormonal changes, and some antibiotics may trigger pain and
other symptoms.

What are the symptoms?

The main symptoms of
irritable bowel syndrome are belly pain with constipation or diarrhea. Other
common symptoms are bloating, mucus in the stools, and a feeling that you have
not completely emptied your bowels.

Many people with IBS go back
and forth between having constipation and having diarrhea. For most people, one
of these happens more often than the other.

IBS is quite common, but most people's symptoms are so mild that they never see a doctor for treatment.
Some people may have troublesome symptoms, especially stomach cramps,
bloating, and diarrhea.

Because there are no structural problems in the
intestines of people who have IBS, some people may think this means that the
symptoms "are all in their head." This isn't true. The pain, discomfort, and
bloating are real.

How is IBS diagnosed?

Most of the time, doctors
can diagnose irritable bowel syndrome from the symptoms. Your doctor will ask
you about your symptoms and past health and will do a physical exam.

In some cases, you may need other tests, such as stool analysis or blood tests. These tests can help your doctor rule out other
problems that might be causing your symptoms.

How is it treated?

Treatment usually includes making changes in your diet and lifestyle, such as
avoiding foods that trigger your symptoms, getting regular exercise, and
managing your stress.

If diet and lifestyle changes don't help enough on their own,
your doctor may prescribe medicines for symptoms such as pain, diarrhea, or constipation.

Cause

The exact cause of
irritable bowel syndrome (IBS) isn't known. But
health experts believe that faulty communication between the brain and the
intestinal tract is one cause of symptoms. In some people, this
miscommunication causes abnormal muscle contractions or spasms, which often
cause cramping pain. The spasms may speed the passage of stool, causing
diarrhea. Or they may slow it down, causing constipation or bloating.

Many people who have IBS seem to have unusually sensitive intestines. It isn't known why their intestines are more likely to react strongly to the
elements that contribute to IBS. People who have IBS may start having symptoms
because of one or more factors, including:

Genetics. IBS may be more likely to occur in people who have a
family history of the disorder.

Symptoms

Symptoms of irritable bowel syndrome include:

Changes in bowel movement patterns.

Bloating and excess gas.

Pain the lower belly.

Mucus in stools.

You are more likely to have IBS if you have these symptoms and they have lasted at least 6 months, you have had belly pain at least 3 days each month for at least 3 months, and at least two of the following are true:1

The pain is relieved by having a bowel movement.

The pain is linked to a change in how often you have a bowel
movement.

The pain is linked to a change in the appearance or consistency
of your stool.

Because there are no structural problems in the
intestines of people who have IBS, some people may think this means that the
symptoms "are all in their head." This isn't true. The pain, discomfort, and
bloating are real. They have many different causes that can be addressed to help
relieve symptoms.

Bowel movement patterns

When you have IBS, your
pattern of bowel movements may be different over time. Two or more of the
following may happen:

Bowel movements may occur either more often (diarrhea) or less
often (constipation) than usual. For example, you may have more than 3 bowel movements a
day or less than 3 a week.

Bowel movements may differ in size or consistency. They may be hard
and small, pencil-thin, or loose and watery.

The way stools pass changes. You may strain, feel an urgent
need to have a bowel movement, or feel that you haven't completely passed a
stool.

You may have bloating or a feeling of gas in the
intestines.

Other intestinal symptoms

Some people may have
pain in the lower belly with constipation that is sometimes followed by diarrhea.
Other people have pain and mild constipation but no diarrhea.

Some people have intestinal gas and passage of
mucus in stools.

Nongastrointestinal symptoms

You may sometimes
have other symptoms that don't affect the intestines, such as:

Anxiety or depression.

Fatigue.

Headache.

An unpleasant taste in the mouth.

Backache.

Sleep problems (insomnia) not caused by symptoms of
IBS.

Sexual problems, such as pain during sex or reduced sexual
desire.

Heart palpitations. (You may feel like your heart skips a beat or is
fluttering.)

Urinary symptoms. (You may have a frequent or urgent need to urinate, trouble
starting the urine stream, or trouble emptying your bladder.)

Symptoms often occur after a meal, during stressful
times, or during menstruation.

What Happens

Symptoms of
irritable bowel syndrome (IBS) may last for a long
time. But IBS doesn't cause cancer or shorten your life.

The pattern of IBS varies from one person to the next and from one bout
to the next. Some people have symptoms off and on for many years. You may go
months or years without having any symptoms. But most people have
symptoms that keep coming back. It is rare for a person to have symptoms
constantly.

Between 7 and 10 out of 100 people in the world have irritable bowel syndrome.2 But most people with IBS don't see a doctor about their symptoms.

What Increases Your Risk

IBS tends to be more
common in:

People in their late 20s.

Women.

People who have panic disorder or other psychological
conditions.

People who have a family history of IBS.

People who have a history of physical or sexual abuse or other
psychological trauma. Several studies have found a link between a past history
of abuse and gastrointestinal disorders.3

People who have other conditions such as
depression,
migraine headaches, and
fibromyalgia.

When To Call a Doctor

Call your doctor if:

You have been diagnosed with
irritable bowel syndrome (IBS) and your symptoms
get worse, begin to disrupt your activities, or don't respond as usual to
your home treatment.

You are more tired than usual.

Your symptoms wake you from sleep.

You have unexplained weight loss.

You have decreased appetite.

You have belly pain that is not linked with changes in
bowel function or that is not relieved when you pass gas or a stool.

You have belly pain that is now in one area (localized) more
than any other area.

You see blood in your stool.

You have a fever.

Watchful waiting

If your symptoms are mild, it might be okay to try home treatment
for 1 week. If you think you may have IBS, try to
rule out other causes of belly problems, such as eating a new food; eating
sugar-rich foods, especially milk products; eating foods containing sorbitol or
other artificial sweeteners; nervousness; or stomach flu. If your symptoms don't get better or if they get worse, call
your doctor.

Who to see

The following health professionals can diagnose and
treat irritable bowel syndrome.

If more tests are needed or your symptoms don't respond
to treatment, it may be helpful to see a doctor who specializes in
treating digestive system problems (gastroenterologist). If stress may be playing a role
in IBS, it may be helpful to see a
psychiatrist or
psychologist.

Exams and Tests

Irritable bowel syndrome (IBS) can be diagnosed based on symptoms. A doctor diagnoses IBS when a person has
the typical symptoms of the disorder and, if needed, tests have ruled out other
possible causes.

Most people won't need tests, but some people may because of their age and symptoms. The amount of testing you get depends on
several things: your age, how your symptoms come on and how severe they are,
and how you respond to your first treatment. For example, a 20-year-old might not need tests. But a 50-year-old with new symptoms might need tests because of the higher risk of colon cancer in people over 50.

Thyroid function tests and other tests, such as colonoscopy, are sometimes done.

Treatment Overview

Treatment for irritable bowel syndrome (IBS) will depend on the types of symptoms you have, how severe they are, and how they affect your daily life. No single type of treatment works best for everyone.

Learn all
you can about IBS so that you and your doctor can work together to find out what may
be triggering your symptoms. You will need to adapt your
lifestyle to best deal with your symptoms and still carry on with your daily
activities. Let your doctor know if parts of your treatment aren't helping your symptoms.

Record your symptoms

The first step in treating IBS usually involves watching and recording your symptoms, your bowel habits, what you eat, and other daily activities (such as exercise) that affect your symptoms. Writing all this down in a notebook for a few weeks can help you and your doctor see patterns of symptoms in your daily life. You may be able to see what things make your symptoms worse (such as eating dairy products) and start to avoid them.

Manage your symptoms

For some people who have IBS, certain
foods may trigger symptoms. These tips may help prevent or
relieve some IBS symptoms:

Limit caffeine and alcohol.

Limit your intake of fatty foods.

If diarrhea is your main symptom, limit dairy products, fruit,
and artificial sweeteners such as sorbitol or xylitol.

Watch for new symptoms

Because IBS is a long-term problem, it's important for you to be aware of big changes in
symptoms. For example, watch for blood in your stools, increased pain,
severe fever, or unexplained weight loss. If any of these occur, your doctor may want to do more tests to find out if there is
another cause for your symptoms.

Your doctor may also want you to try different medicines, or different
dosages of your current medicines, if your symptoms aren't responding to
treatment.

Prevention

You can't prevent
irritable bowel syndrome (IBS). But proper
self-care may help ease symptoms and may extend the time between
episodes. Self-care includes quitting smoking, avoiding caffeine and foods that make
symptoms worse, and getting regular exercise.

Home Treatment

For most people who have
irritable bowel syndrome (IBS), home treatment may be
the best way to manage the symptoms. It is also helpful to learn all you can
about IBS so you can better share your concerns and questions with your
doctor.

Careful attention to diet, exercise, and stress management should help keep your symptoms
under control. They may even prevent your symptoms from coming back.

Diet

In many people who have IBS,
eating may trigger symptoms. But for most people, there is not a
certain type of food that triggers symptoms.

Increasing the amount of fiber in your diet can help control constipation. High-fiber foods
include fresh fruits (raspberries, pears, apples), fresh vegetables (carrots, leafy greens), wheat bran, and whole-grain breads and cereals. Beans such
as kidney, pinto, and garbanzo are also high-fiber foods. (So are vegetables such as peas, cabbage, and broccoli.) But they should
probably be avoided if gas is one of your symptoms.

If you have trouble getting enough fiber in your diet, you can take a fiber supplement such as psyllium (for example, Metamucil) or wheat dextrin (for example, Benefiber). If you take a fiber supplement, read and follow all instructions on the label. Also, make sure to drink plenty of fluids, enough so that your urine is light yellow or clear like water.

You can take
steps to make it less likely that certain foods will cause symptoms. For example, avoid or limit gas-producing foods (including beans and cabbage),
sugarless chewing gum and candy, caffeine, and alcohol.

Exercise

Getting more exercise can make your symptoms less severe. Exercise also can improve your quality of life (especially how well you sleep, your energy level, and your emotional and social life).4

Getting more exercise doesn't have to be hard. In one study, people with IBS increased their activity level by adding 20 to 60 minutes of moderate- to vigorous-intensity physical activity, 3 to 5 days a week. They did activities such as swimming, jogging, cycling, and walking.

In the group that did not increase their activity level, more people had an increase in their IBS symptoms. These people weren't active, and their symptoms got worse.4

Stress

If stress seems to trigger your
symptoms, these tips may help you better manage stress and avoid or ease
some IBS episodes:

Keep a diary or journal of your symptoms as well as life events
that occur with them. This often helps clarify the connection between symptoms
and stressful occasions. After you have identified certain events or situations
that bring on symptoms, you can find ways to deal with these
situations.

Get regular, vigorous exercise (such as swimming, jogging, or
brisk walking) to help reduce tension.

A hobby or an outside activity can provide a break from
stressful situations.

Find a support group. In a support group, you can share with other people who have IBS.

Psychiatrists, psychologists, hypnotists, counselors, social
workers, and biofeedback specialists can provide methods for coping with
stress.

Medications

Medicine may be used along with
lifestyle changes to manage symptoms of
irritable bowel syndrome (IBS). It may be prescribed to treat moderate to
severe pain, diarrhea, or constipation that does not respond to home treatment.

Medicine can help relieve your symptoms enough to prevent them from
interfering with your daily activities. It may not be possible to
eliminate your symptoms.

In most cases, the choice of medicine is based on your
most troublesome symptom. For example, if diarrhea is the most bothersome
symptom, using antidiarrheals or anticholinergics may be helpful.

Few medicines have proved
consistently helpful, and all medicines have side effects. So medicine should
be used for specific symptoms that disrupt your normal daily activities.

If you also have another illness, such as depression, that triggers
symptoms of irritable bowel syndrome, medicine for that illness may be
needed.

Diarrhea medicines

Medicines that may be used to
treat severe diarrhea that does not improve with home treatment include:

Antidiarrheals, including atropine and diphenoxylate (such as Lomotil) and
loperamide (such as Imodium).

Rifaximin (Xifaxan), which has been shown to help people who have diarrhea and bloating as their worst symptoms. In one study, people who had fewer symptoms after 2 weeks of taking rifaximin continued to have fewer symptoms for 10 weeks after stopping the medicine. But rifaximin is very expensive, and more research needs to be done. There are still many questions about this treatment, including who will get the most benefit, how long the effect will last, and whether retreatment will work when symptoms come back.5

Alosetron (Lotronex), which is used for some women who
have severe diarrhea. This medicine has been shown to contribute to ischemic bowel disease. Specific guidelines for the use of alosetron require doctors who prescribe it to sign a certificate and patients to sign a consent form.

Constipation medicines

There are many medicines for severe
constipation that doesn't improve with home treatment. Most of these medicines are available without a prescription and are okay to take once in a while. Check with your doctor before you use any of these medicines every day for constipation. Medicines for constipation include:

Osmotic laxatives (such as Milk of Magnesia and nonabsorbable
sugars such as lactulose).

Polyethylene glycol (such as MiraLax).

Stimulant laxatives (such as Senokot).

Linaclotide (Linzess).

Lubiprostone (Amitiza).

Pain and cramping

The following medicines
may be used for long-term pain and cramping:

Anticholinergics (antispasmodics). These include dicyclomine
(Bentyl).

Antidepressants, including desipramine (such as Norpramin). In low doses, they can help with pain caused by IBS.

Depression

The following
medicines may be used if your IBS causes you to have anxiety or
depression:

Antidepressants, including fluoxetine (such as Prozac). They are especially helpful if you have depression and IBS.

Antianxiety agents, including diazepam (such as Valium). These can be used short-term to help with anxiety if it makes your IBS symptoms worse.

Other Treatment

A wide range of other
treatments can be used to treat
irritable bowel syndrome (IBS).

Psychological treatment

Some kinds of psychological treatment may help with IBS symptoms. These treatments include cognitive-behavioral therapy, psychotherapy, and hypnosis.6

People who practiced thinking positively using CBT reduced their IBS symptoms, anxiety, and negative thoughts and improved their quality of life compared to people who practiced stress management exercises.7

Other psychological treatments that are sometimes used for IBS include relaxation therapy, meditation, and biofeedback.

People who have IBS are
more likely than people without the condition to have
depression, panic disorder, or other psychological
conditions.1 Acknowledging these factors may help you and your doctor successfully manage your condition.

Complementary treatment

IBS is different for each person, and no medicines have been proved to work
really well for IBS. So people often try alternative or complementary treatments.
Some of these treatments have been studied, and some have not.

Acupuncture is used as a treatment for IBS. But how well it works to treat IBS is still unknown.10

Peppermint oil has also been used to treat IBS. Studies have
shown that peppermint oil works to improve IBS symptoms by preventing cramps and spasms in the intestines.6

Aloe is commonly used for IBS, especially IBS with
constipation. There is currently no evidence for the use of aloe as an
effective treatment for IBS.

Ginger has been used to treat nausea. It has been studied as
a treatment for nausea caused by seasickness and surgery. It isn't known how
well ginger helps in IBS.

Helpful bacteria, called probiotics, may help with IBS symptoms. In one study, people with IBS who took a daily pill containing the bacteria Bifidobacterium bifidum had fewer symptoms after 1 month compared with people who took a placebo pill. And almost half of the people taking the probiotic had what they considered "adequate" relief of symptoms.11 Other studies show that a supplement with a combination of types (called strains) of bacteria probably helps more than just one type. But more research is needed.6

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